Blacks in the United States have a higher prevalence of hypertension and diabetes and a higher risk of developing hypertensive and diabetic end- stage renal disease (ESRD) than whites. Despite this, blacks who develop ESRD and undergo dialysis live longer than white patients. These racial differences in mortality are poorly understood. They could arise from differences in access to renal replacement therapy, health status prior to development of ESRD and in the type and intensity of ESRD treatment. This study will investigate racial differences in risk factors, clinical disease and mortality related to the cardiovascular system among ESRD patients in the United States. Cardiovascular disease is very common in ESRD, accounting for up to 50 percent of all deaths in dialysis patients, due in large part to the high prevalence of risk factors such as hypertension and diabetes in this population. We will study a 1986-87 incident cohort of 4159 Medicare-entitled, ESRD patients using data from the, United States Renal Data System special case-mix severity study. First, we will perform a cross-sectional study to examine racial differences in pre-ESRD risk factors for cardiovascular disease and pre- ESRD comorbid cardiovascular disease. Second, we will use a prospective, longitudinal study design and data on admission to the hospital for cardiovascular events and date of death to examine racial differences in the hospitalization for cardiovascular disease, overall mortality and cardiovascular disease-specific mortality among dialysis patients. In particular, we will examine whether racial differences in mortality and cardiovascular disease can be explained by racial differences in pre-ESRD risk factors or comorbid disease. We will also assess whether racial differences in risk factors, comorbid disease and mortality are consistent across gender and age groups. The study will use multivariate models, including logistic and multiple regression and proportional hazards models, to adjust simultaneously for differences in factors that could confound associations between race and disease or survival. The results of this research will improve our understanding of racial differences in disease in the United States ESRD population and provide information which could be used in the future to direct efforts at the prevention or treatment of cardiovascular disease in ESRD.